Traumatic events are a tragic but common occurrence. Incidents such as death, war, natural disasters, or accidents can lead to traumatic experiences that affect people of all ages and backgrounds. While some people experience temporary emotional turbulence following trauma, others will go on to develop a more serious condition known as post-traumatic stress disorder (PTSD). These individuals are so deeply affected by the event that they experience intense, uncomfortable symptoms for an extended period and find it difficult to live a normal life.
According to the American Psychiatric Association, PTSD affects roughly 3.5% of the population each year. An estimated 1 in 11 people are also diagnosed with PTSD in their lifetime. Findings have also indicated that in the U.S., 80% of individuals with PTSD have co-occurring depression, anxiety, and/or substance use disorders.
However, despite the strong link between PTSD and substance abuse, there is ample hope for recovery. In this article, we outline what PTSD is, how it relates to substance abuse, and what types of treatments are available.
What Is PTSD?
PTSD is a mental health condition that can develop after a person witnesses or experiences a distressing event. Previously known as “shell shock” and “combat fatigue” following World Wars I and II, PTSD was originally associated with war veterans. However, today PTSD is known to affect people of all ages, cultures, and backgrounds.
Some of the most common traumatic events that can lead to PTSD include:
- Violent assault
- Natural disasters
- Military combat
- Sexual assault or rape
- Childhood abuse
- Death
- Accidents
- Medical procedures
While not everyone who experiences trauma develops PTSD, those who do can experience disturbing symptoms long after the event has ended. These include flashbacks, nightmares, insomnia, depression, intense anxiety, distorted thinking, and an inability to face situations that remind them of the event.
How Does PTSD Develop?
Research indicates that while 70% of the U.S. population has experienced a traumatic event within their lifetimes, only 8% go on to develop PTSD. There are several reasons for this, but some of the most common are one’s coping skills, perception of helplessness, whether they’ve experienced trauma before, and whether there are any underlying mental health conditions. PTSD also develops in specific ways, as outlined below.
Fight or Flight
PTSD develops in the body’s stress response system. When we encounter stressful situations, our sympathetic nervous system responds with what is known as “fight, flight, or freeze.” This triggers the release of cortisol, a stress hormone that causes us to either confront the threat (fight), retreat from the threat (flight), or dissociate (freeze).
In a healthy scenario, a person’s stress system will calm down and return to normal once the parasympathetic nervous system (known as rest, digest, and heal) takes over. However, in people with PTSD, the fight or flight mechanism never switches off and they don’t enter the parasympathetic state.
This results in an “always-on” scenario where a person feels on edge and on guard as though the threat is still present. Unsurprisingly, this hyper-alert state can lead to a host of physical, emotional, and behavioral problems, such as depression, chronic fatigue, and substance use disorder.
Brain Changes
Another reason that PTSD can develop and become so debilitating is because of the way that trauma can change the brain in areas where thinking occurs. According to trauma expert, Bessel Van der Kolk, this change in brain structure produces specific effects:
- Trauma causes a person to perceive threats where others see manageable situations.
- Trauma can damage a person’s filtering system, which means they find it difficult to distinguish between what matters now and what doesn’t.
- Trauma can alter or dampen your sense of self, including your ability to feel pleasure and connect with others.
The combination of these brain changes with the body’s hyper-alert state makes PTSD a debilitating condition. It is therefore no surprise that individuals frequently turn to substances as a way to cope.
Underlying Risk Factors
While there is no way to predict whether someone will develop PTSD, there are several underlying risk factors. For example, women are twice as likely to develop the condition than men. Other risk factors include:
Previous Trauma
People who have experienced previous traumas, such as accidents, natural disasters, or acts of violence are more prone to developing PTSD in times of stress. These situations can have a cumulative effect and each new experience can exacerbate the other.
Poor Coping Skills
Your coping skills matter a great deal when it comes to dealing with stressful events. People with low coping ability or psychological functioning can be more susceptible to PTSD, as they can blame themselves or feel they have little control over their circumstances.
Having Little or No Social Support After the Event
People who lack support networks are more vulnerable to PTSD following trauma. This is especially the case if a person is living in an environment of shame, guilt, or stigmatization. Conversely, research indicates that individuals who have positive social and family relationships can be better equipped to moderate the effects of trauma.
Ongoing Stress
Stress and traumatic feelings can be cumulative; therefore, if you’ve recently been through trauma and are dealing with ongoing stress in other areas of life, you are more prone to developing PTSD. For example, if a loved one has just passed away and you are still having to attend a stressful job, it can be difficult to cope with your feelings.
Having a History of Mental Illness or Substance Abuse
Co-occurring conditions, whether they’re physical or psychiatric, can also augment the symptoms of PTSD. This is especially the case for people who have concurrent depression, anxiety, or other mood disorders.
High-Risk Groups
High-risk groups can also be a factor in developing PTSD. As mentioned, veterans or individuals who have been in military combat are highly susceptible. Not only can these individuals experience PTSD after they return from war, but they can also have it while they’re on duty. This can make the demands of the job incredibly difficult.
Symptoms of PTSD
Post-traumatic stress disorder is grouped into a set of categorical symptoms. The most common of these are:
Re-Experiencing Symptoms
- Flashbacks—reliving the trauma over and over, including physical symptoms, like a racing heart or sweating.
- Bad dreams or nightmares.
- Frightening thoughts.
- Recurrent, involuntary, and troubling memories of the event.
- Frequent distressing dreams about the event.
- Intense or long-lasting psychological distress after being exposed to things that remind them of what happened.
- Physical reactions to reminders of the event, such as a tense stomach.
Avoidance Symptoms
- Staying away from places, events, or objects that are reminders of the traumatic experience.
- Avoiding thoughts or feelings related to the traumatic event.
Arousal and Reactivity Symptoms
- Being easily startled.
- Feeling tense or “on edge.”
- Having difficulty sleeping.
- Irritability and anger.
- Reckless or self-destructive behavior.
- Hypervigilance.
- Struggling with concentration.
- Trouble sleeping.
Cognition and Mood Symptoms
- Difficulty remembering key features of the traumatic event.
- Negative thoughts about oneself or the world.
- Distorted feelings, like guilt or blame.
- Loss of interest in enjoyable activities.
- Lack of ability to recall key parts of the trauma.
- Feelings of detachment from others.
- Persistent and inaccurate negative beliefs about oneself, others, or the world.
- Persistent, flawed beliefs about the cause or consequences of the event, which typically leads a person to blame themselves or others.
- Enduring inability to experience positive emotions.
PTSD & Substance Abuse Stats
It is estimated that roughly 8 million Americans are affected by PTSD each year, although rates of trauma exposure can be as high as 60% in the general population. Also, according to the U.S. Department of Veteran Affairs, people with PTSD are almost twice as likely to have an alcohol addiction than the general population.
Other stats include:
- Approximately 33% of veterans who seek addiction treatment also have PTSD. Another study in the 1980s found that 74% of Vietnam veterans who had PTSD also had a substance abuse problem.
- According to a national epidemiologic study, 46.4% of individuals with lifetime PTSD also met the criteria for substance abuse disorder.
- Roughly 50% of people undergoing inpatient substance abuse treatment also have PTSD.
- Nearly 80% of women who seek substance abuse treatment have lifetime histories of sexual or physical abuse.
- People who abuse cocaine and opiates report higher rates of exposure or instances of trauma than individuals who use other substances.
- In one clinical study of traumatized populations, high rates of lifetime dependence on various substances were found (39% used alcohol, 34.1% used cocaine, 6.2% used heroin and other opiates, and 44.8% used cannabis).
PTSD and Addiction
Due to the intense symptoms of PTSD, many people turn to substances in order to cope. Part of this is because PTSD affects people in very physical ways, not just mentally and emotionally. Therefore, PTSD isn’t something you can just “think your way out of.” As a way of dealing with these very intense symptoms, many people with PTSD turn to substances, as described below.
Self-Medicating Behavior
One of the main reasons that people with PTSD resort to substances is to self-medicate. As mentioned earlier, nearly 50% of individuals with PTSD also have substance abuse problems. Individuals will often attempt to mask the intense physical and emotional symptoms while trying to escape recurring thoughts about the troubling event.
However, the problem with self-medicating is that substances not only exacerbate depressive and anxious symptoms during use, but drug withdrawal can also lead to increased depression. While PTSD can be incredibly distressing and debilitating, it is advisable to seek help first before turning to alcohol or drugs, as you can worsen your situation and make it more difficult to cope.
Endorphin Withdrawal
Endorphin withdrawal is another key trigger for alcohol or drug use. When a person experiences a traumatic event, their brain releases endorphins, which are neurotransmitters that reduce pain and create a sense of well-being. While these pleasure chemicals are the body’s way of coping with the stressful event, a person can experience endorphin withdrawal once the event passes. These withdrawal symptoms are similar to alcohol or drug withdrawal and can include anxiety, depression, physical pain, or emotional distress. Therefore, many people with PTSD will turn to substances as a way of coping with this lack of endorphins.
How Does Substance Abuse Affect PTSD?
Another factor when it comes to PTSD and substance abuse is how they affect each other. Below, we discuss some of the substances that are commonly abused by individuals with PTSD, and describe what the effects are.
Alcohol & PTSD
Alcohol is a commonly abused substance among people with PTSD due to its numbing effects and its ability to block out traumatic memories and emotions. However, alcohol also worsens PTSD symptoms, especially when the effects wear off. Alcohol is a depressant, so it can leave a person feeling more depressed when they stop drinking. It can also interfere with sleep and can trigger more intense nightmares. Heavy alcohol use is also known to cause dissociative episodes, where people engage in risky or self-destructive behaviors.
While drinking on occasion isn’t necessarily a bad thing, using it as a crutch can lead to long-term health problems. If you find yourself in a cycle of drinking to cope with PTSD, you could also end up with extended, and more extreme symptoms than before.
Smoking & PTSD
Smoking is another highly abused substance amongst people with PTSD when compared with the general population. Tobacco has both a stimulating and a calming effect on the body, which is why individuals turn to it as a crutch during difficult times. However, tobacco not only comes with a wide range of health risks, including heart disease and cancer, but like other drugs, it can also worsen PTSD symptoms. Tobacco’s stimulant effect can enhance or intensify avoidance symptoms (such as withdrawal from stress-inducing situations) and trigger intrusive ones (such as psychological distress), as well.
Opioids & PTSD
People with PTSD are sometimes prescribed opioid painkillers to help relieve some of their physical symptoms. Alternatively, individuals sometimes turn to illicit opioids, like heroin or fentanyl, as a way of self-medicating and numbing uncomfortable feelings.
Like all drugs, the problem with opioids is that they are highly addictive and generate uncomfortable withdrawal effects when use is stopped. These withdrawal signs can exacerbate PTSD symptoms, such as depression, anxiety, and sleep problems, and can create new symptoms at the same time.
Cannabis & PTSD
As cannabis is becoming more widespread and legalized across the world, it is also a common drug of choice for people wanting to escape the effects of PTSD. However, research has shown that cannabis and PTSD affect the same endocannabinoid system in the brain.
Therefore, while cannabis can produce calming effects, it can also amplify dissociative symptoms and trigger emotional instability and avoidance symptoms. If cannabis use is increased to the point where a person develops a tolerance to the drug, it can also trigger other symptoms, such as paranoia, anxiety, hypervigilance, and hyperarousal.
Signs of Addiction
If you’re struggling with PTSD and are concerned about your alcohol or drug use, below are some key signs to watch out for, as they can be clear indications of addiction.
Tolerance
This physiological state occurs when your body is used to the drug and requires larger amounts to achieve the desired effects.
Withdrawal
These symptoms present as physical and emotional discomfort, such as nausea, tremors, nervousness, cold sweats, or agitation when stopping drug use.
Remorse
This emotional state occurs if your drug use has led you to feel guilty or sad, even though you are taking the substance to feel better.
Relapse
This happens if you try to stop taking the drug but find yourself going back to it due to intense cravings or withdrawal symptoms.
PTSD & Substance Abuse Treatment Options
The good news is that despite the intensity of PTSD symptoms and the high rates of co-occurring substance abuse, treatment is available. While these conditions can be treated separately, they are best managed simultaneously, using multiple levels of care that begin with detox and continue through to inpatient/residential, outpatient, and aftercare programs.
If you need to seek help, many of these treatment programs are found in rehab facilities or drug treatment centers across the country.
Dual Diagnosis
Centers that offer dual diagnosis treatment are recommended, as they are set up to diagnose and treat concurrent mental health conditions and substance abuse. This kind of treatment is especially useful for people who have underlying issues, such as depression and PTSD. Dual diagnosis programs allow clinicians to safely address these conditions while an individual withdraws from alcohol or drugs. Dual diagnosis treatment programs can be found in both inpatient and outpatient clinics.
Key Therapies
Other key treatments to be aware of when it comes to PTSD and substance abuse are:
Somatic Experiencing (SE)
Somatic Experiencing is a revolutionary, body-oriented therapeutic model for releasing trauma. Developed by Dr. Peter Levine, this type of therapy addresses the physiological fight or flight system that remains active in traumatized individuals. It works by treating the central nervous system and teaching people how to get in touch with the bodily sensations that arise with memories of traumatic events. This form of therapy has proven to be highly effective and long lasting and is helpful with all kinds of trauma, including that experienced by veterans.
Seeking Safety
Seeking Safety is an evidence-based counseling model that helps individuals attain safety from trauma and/or substance abuse. The sessions can be delivered in individual or group settings and consist of numerous topics, such as:
- PTSD: Taking Back Your Power
- When Substances Control You
- Setting Boundaries in Relationships
- Detaching from Emotional Pain (Grounding)
- Coping with Triggers
- Self-Nurturing
Seeking Safety has been successfully implemented across vulnerable populations, including the homeless, victims of domestic violence, military personnel, and more. It has also proven to be effective for all types of addictions, making it a useful therapy for individuals with PTSD and substance abuse issues.
Eye Movement Desensitization and Reprocessing (EMDR)
Other trauma-informed treatments such as EMDR are also effective. Consisting of 8 phases, EMDR is led by a therapist who guides an individual through a series of rapid eye movements to help redirect negative or traumatic memories. This redirection helps the person form new connections or associations, so that the memory is less emotionally distressing over time. This therapy is therefore useful for individuals with mood disorders, as it helps them overcome the emotional suffering associated with traumatic events.
Cognitive-Behavioral Therapy (CBT)
Another effective therapy for PTSD and substance abuse is cognitive-behavioral therapy (CBT). CBT helps individuals change negative cycles of thought and behavior into more positive ones and this has shown to be especially effective for addiction and mental health conditions. Clients receiving CBT for addiction learn how to recognize “automatic thoughts” and dysfunctional thinking patterns, how to understand the behavior and motivation of others, and how to develop a greater sense of self-understanding and confidence. CBT also helps clients find solutions to triggers that might encourage drug use.
Dialectical-Behavior Therapy (DBT)
Dialectical-behavior therapy (DBT) is a type of cognitive-behavioral therapy that focuses on mindfulness, how to live in the moment, cope with stress, and improve relationships. DBT also helps clients better regulate their moods and learn how to develop healthy coping skills. This kind of therapy is useful for people who have co-occurring conditions, especially those who have depression or bipolar symptoms. DBT is also effective for PTSD and for people who exhibit self-destructive behaviors.
Motivational Interviewing (MI)
Motivational Interviewing (MI) is a type of collaborative therapy between a therapist and the client. During these sessions, the client and therapist work together to define sources of motivation and achieve self-defined goals. MI is known for its positive, client-centered approach and has shown to be effective in treating addiction and mood disorders.
Medications
There are many different types of medications that are prescribed to treat PTSD. Below are a few of the most common.
Serotonin Reuptake Inhibitors (SSRIs)
These anti-depressants work by increasing the amount of available serotonin in the brain, a neurochemical that stabilizes mood. SSRIs are also a popular treatment for depression and are helpful for people with PTSD because they tend to have fewer side effects compared with other anti-depressants. Common SSRIs include Prozac, Celexa, and Zoloft.
Other Anti-Depressants
Other anti-depressants, such as serotonin and norepinephrine reuptake inhibitors (SNRIs), improve serotonin and norepinephrine in the brain, which can help reduce depressive symptoms. Common SNRIs include Pristiq, Cymbalta, Fetzima, and Effexor. Cymbalta is also known to help with pain relief, which can help PTSD sufferers with chronic pain issues.
Mood Stabilizers
Mood stabilizers such as Lamictal, Gabitril, and Depakote are sometimes useful to help individuals who are struggling with depression and mood swings.
Antipsychotics
Antipsychotics can be useful for people who suffer from agitation, dissociation, hypervigilance, and paranoia. When used in combination with an SSRI, antipsychotics like Risperdal, Seroquel, or Abilify can help people with these kinds of PTSD symptoms.
Alternative or Holistic Therapies
Holistic therapies are also effective at treating addiction and mood issues. The purpose of holistic therapies is to treat the whole person and not just the symptoms. These can be incredibly beneficial for providing calmness, spiritual support, emotional expression, improving physical health, and teaching valuable coping skills. Some of the most popular holistic therapies include:
- Relaxation techniques
- Nutritional therapy
- Animal-assisted therapy (e.g., emotional support dogs)
- Massage
- Adventure therapy (e.g., hiking or rock climbing)
- Mindfulness and meditation
- Art and music therapy
- Yoga and Tai-Chi
- Equine-assisted (horse) therapy
Long-Term Recovery
Alongside these treatments, there are other ways to enhance your recovery by making personal lifestyle adjustments like the ones below:
Exercise
Vigorous activity can stimulate endorphins, which can help with anxiety, depression, and low mood. Examples include low- and high-intensity exercises, such as walking, running, swimming, cycling, or yoga.
Meditation
This can help calm anxious or racing thoughts and improve cognitive function, which is useful when recovering from PTSD and addiction.
Eating Well
The right diet can help repair the damage incurred following sustained drug use and lead to improved immunity, cognitive function, and energy.
Avoiding Triggers
Learning to avoid triggers like certain people, situations, or circumstances can help prevent a desire to take drugs.
New Hobbies
While cravings can be difficult to manage, hobbies such as sports, art, music, or crafts can be useful distractions.
Resources
If you or a loved one are struggling with PTSD and substance abuse or addiction, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.
You can also find a list of treatment centers near you on our website to help get you on the path to recovery.
Key Sources
American Psychiatric Association. (2021). What Is Posttraumatic Stress Disorder? Psychiatry.org. https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd.
Editorial Staff. (2015). Trauma-Informed Approach and Trauma-Specific Interventions. Mental Health.org. https://www.mentalhealth.org/get-help/trauma.
Hien, D., et al. (2009). Women’s Treatment for Trauma and Substance Use Disorders. J Consult Clin Psychol. 77(4), 607–619. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2795638/.
Khoury, L., Tang, Y., Bradley, B., Cubells, J., and Ressler, K.J. (2010). Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depress Anxiety. 27(12), 1077–1086. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051362/.
Lesser, B. (2021). The Link Between PTSD and Addiction. Dual Diagnosis.org. https://dualdiagnosis.org/mental-health-and-addiction/post-traumatic-stress-disorder-and-addiction.
National Institute for the Clinical Application of Behavioral Medicine. (2021). Three Ways Trauma Changes the Brain. https://www.nicabm.com/trauma-three-ways-trauma-changes-the-brain.
National Institute of Mental Health. (2021). Post-Traumatic Stress Disorder. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd.
Somatic Experiencing International. https://traumahealing.org/about.
U.S. Department of Veteran Affairs. (2021). Treatment of Co-Occurring PTSD and Substance Use Disorder in VA. https://www.ptsd.va.gov/professional/treat/cooccurring/tx_sud_va.asp.
Medical Disclaimer
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